Challenges in Clinical Electrocardiography |

An Unusual Pattern of ST-Segment Elevation

Prashant D. Bhave, MD; Nora Goldschlager, MD
Arch Intern Med. 2011;171(13):1146. doi:10.1001/archinternmed.2011.285.
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A 40-year-old man with methamphetamine-induced dilated cardiomyopathy was referred from clinic to the emergency department after having had an episode of chest pain during his clinic visit. The patient reported exertional chest discomfort, described as a pressure-like sensation accompanied by sweating. The discomfort resolved with rest and sublingual nitroglycerin. He admitted to recent methamphetamine use. His blood pressure was 136/70 mm Hg, and his heart rate was regular at 99 beats/min. The jugular venous pressure was mildly elevated, and an S3 gallop was audible at the apex. His initial troponin-I level was 0.10 ng/mL (normal, <0.10 ng/mL). An electrocardiogram (ECG) showed normal sinus rhythm and left ventricular hypertrophy with associated repolarization abnormalities.

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Figure 1.

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Figure 2. A repeated tracing showing normal sinus rhythm with resolution of anterior and inferior ST elevations. Q-waves in the right precordial leads have also resolved. New findings include ST elevation in leads I and aVL and inferior ST depressions. AV nodal conduction has normalized. There remains a right axis deviation. Precordial lead artifact is a result of poor electrode contact.




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